anal CA dosing

[CUBuffsgrad98]

What are most people doing now? IMRT? If so, what are you dosing the primary to? NCI study was 54 Gy or higher, RTOG is 50.4 or 54. Any thoughts?

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[Gfunk6]

I follow RTOG dosing guidelines. 50.4 to T2N0 and 54 to T3 or N+

 

[medgator]

I follow RTOG dosing guidelines. 50.4 to T2N0 and 54 to T3 or N+

Just to clarify, this is based off the most recent RTOG study looking at dose-painted IMRT (0529). I will take the primary to 50-54 in most cases, but after seeing local failures for large T3/T4 tumors, I do not hesitate to take them to 59.4 sometimes when it's tolerated (this dose was used in the prior RTOG trial 98-11).

If Nigro was right, all we really need is 30 Gy

 

[Palex80]

A major point to be made is radiation-therapy breaks. Modern studies no longer feature pauses in radiation therapy, but many of the data on dose-response comes from older trials, where radiation therapy breaks were quite often in anal cancer RT.

We give 54-55.8 for T1/T2 and 59.4 for T3/T4.

I wonder what people give for pathologic LN too. Elective doses in the range of 36-45 Gy are custom, but you guys give more than 54 Gy for pathologic LN?

Another point is chemo. Standard for most of patients, but there's very limited data on value of chemo for T1N0-disease. We usually don't give chemo for T1N0.

 

[medgator]

A major point to be made is radiation-therapy breaks. Modern studies no longer feature pauses in radiation therapy, but many of the data on dose-response comes from older trials, where radiation therapy breaks were quite often in anal cancer RT.

We give 54-55.8 for T1/T2 and 59.4 for T3/T4.

I wonder what people give for pathologic LN too. Elective doses in the range of 36-45 Gy are custom, but you guys give more than 54 Gy for pathologic LN?

I give 50-54 for involved nodes. I only take the primary to 59.4 when I do treat to that dose.

I have 2 anal canals on treatment right now, and quite frankly, I am not frying them on the bottom as much as the 5FU/MMC is frying them on the top One of them is on break in the hospital for pancytopenia after her first cycle. Both of them complain about the oral stomatitis/mucositis more than anything else. I wish the chemo had come along as far as IMRT has.

 

[seper]

I follow RTOF 0529 dosing (primary to 54Gy, nodes to 50. 4 or 54 depending on size).
I agree that no clear evidence on further dose escalaction exist yet.

Regarding cytopenia, I actually came to believe recent studies on IMRT and bone marrow dose, and started to heavily constrain pelvic bones in field with my VMAT planning.

 

[OTN]

I'm with GFunk. RTOG dosing.